Albert M. Cook Faculty of Rehabilitation Medicine and Faculty of...

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Issues in AAC Albert M. Cook Faculty of Rehabilitation Medicine and Faculty of Extension University of Alberta Colloque 2.0 RéadaptATion - Aides techniques 13 May 2011

Transcript of Albert M. Cook Faculty of Rehabilitation Medicine and Faculty of...

Page 1: Albert M. Cook Faculty of Rehabilitation Medicine and Faculty of …aerdpq.reseaut.net/fichiers/evenement/conference/5-ac_a... · 2011-08-15 · Issues in AAC Albert M. Cook Faculty

Issues in AAC

Albert M. Cook Faculty of Rehabilitation Medicine

and Faculty of Extension University of Alberta

Colloque

2.0 RéadaptATion

-

Aides techniques

13 May 2011

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Issues in AAC•

Attitudes impact AAC effectiveness

Variety of AAC techniques and strategies

AAC is multi-modal•

There are barriers to successful AAC use

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Issues in AAC•

Attitudes impact AAC effectiveness

Variety of AAC techniques and strategies

AAC is multi-modal•

There are barriers to successful AAC use

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Attitudes impact AAC effectiveness

Family•

Friends

Peers•

Strangers

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Circle of Friends5

432

1 Client

Fifth circle –

Unfamiliar partners (“everyone else”

who doesn't fit in the first four circles)

Fourth circle –Paid workers (SLP, PT, OT teachers, educational assistant, babysitter)

Third circle –

Acquaintances (neighbors, schoolmates, bus driver, shop keeper)

Second Circle – Close

friends/relatives

First circle life-

long communication partners

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Attitudes and Acceptance of AAC by Families

Families and peers may be uncomfortable with the AAC strategies because of worries that such approaches might impede the return or development of natural speech

Authenticity of the messages and stories that are stored in AAC systems is questioned, especially when SGDs are used.

A recurrent theme is whether the individual with severe, chronic aphasia actually authored the messages

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Acceptance of AAC

Extends beyond individuals with aphasia and includes their family, friends, and peers

Families often prefer natural speech for their loved ones

People less familiar prefer AAC strategies

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Comparison of Mother’s & Fathers AAC GoalsNeed Mother (%) Father (%)Programming knowledge * 4(43.5)Maintenance repair info * 2(48.9)Increasing AAC knowledge 4(46.4) 3(44.7)Integrating AAC at home * 3(44.7)Integrating AAC in comm. 2(44.8) *Integrating AAC in school * 4(43.5)Planning for future needs 5(44.6) 1(50.0)Getting computer access * 5(43.2)More peer social opp. 3(47.6) *More typical social opp. 1(54.1) *

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Attitudes of Partners

General public•

Children

Teachers•

Co-workers

Strangers

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Attitudes About and Acceptance of Augmentative and Alternative

Communication

Factors affecting attitudes toward individuals who rely on AAC

Gender•

Type of disability

Age, experience of the user of AAC, •

Experience and familiarity with disability and AAC by the partner

Social context

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Attitudes-General public

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Attitudes of children who do not have disabilities toward children who use AAC

Influenced by familiarity with children who have disabilities

Girls are more positive than boys

Older children can be less positive than younger children

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Attitudes of children who do not have disabilities toward

children who use AAC

•Much interaction among peers is not affected by AAC system type

•Voice output can lead to more positive peer attitudes than letter displays

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Attitudes of children: Meeting a Friend

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Attitudes About and Acceptance of Augmentative and Alternative Communication in Classrooms

•Success dependent on attitudes of general education teachers (circle 4) •Students who use AAC & typically developing classmates can develop skills and positive interactions during classroom activities•Unequal status and dissimilar interests lead to social exclusion for students who rely on AAC

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Attitudes About and Acceptance of Augmentative and Alternative Communication in Classrooms

Peers speak to teacher or assistant not child

Concern about lack of academic gain

Device features (e.g., speech synthesis) are perceived as disruptive to other students.

School-related barriers :–

large class sizes

physical layout of the classroom

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Attitudes About and Acceptance of AAC in Employment

Benefits:•

Worker: social interaction, personal enjoyment, and financial gain.

Employer: positive impacts on other employees, high quality of work loyalty of the employee

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Attitudes About and Acceptance of in AAC Employment

Employment challenges •

Finding a good job match to individual skills

Communication (e.g., noisy AAC device, speaker phone use)

Difficulty with typical office tasks (e.g., manipulation of paper, telephone use)

Education or vocational skill level too low

Lack of knowledge of work culture

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Issues in AAC•

Attitudes impact AAC effectiveness

Variety of AAC techniques and strategies

AAC is multi-modal•

There are barriers to successful AAC use

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Types of Communicators*•

Emergent communicators –

no reliable method

of symbolic expression, here and now concepts only

Context-dependent communicators –

reliable symbolic communicating but limited to specific context because:–

Only intelligible to familiar partners

Insufficient vocabulary•

Independent communicators –unfamiliar &

familiar partners on any topic

*Dowden and Cook, 2004

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Multiple modes for AAC

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Some Fundamental Principles in AAC Technologies-each enhanced interaction

Language organization, storage and retrieval software

Abbreviation expansion •

Word completion and prediction

Dynamic displays •

EADL as an appliance control w/ IR output

Visual Scene displays•

Cell phone capability

Scanning –

sequential access

Selection Methods •

Programmable keyboards

Head-pointing & Eye pointing as control interfaces

Speech synthesis•

Text-to-speech algorithms

Digital speech compression

… and more

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A wide range of techniques, strategies and technologies are required to support individual’s with complex communication needs (CCN)

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Some AAC Options

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Cognitive Processing AidsPDA used as prompt for procedures

On screen abbreviation expansion and word prediction for writing

PDA used to aid in memory using pictures for list

PDA-based orientation and way finding

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HARD AND SOFT TECHNOLOGIES•

Hard technologies:–

readily available components

can be purchased and assembled into assistive technology systems.

main distinguishing feature is that they are tangible.

Soft technologies:–

human areas of decision making, strategies, training, concept formation,

generally captured in one of three forms: people, written instructions or manuals, and computer help screens

more difficult to acquireOdor P: Hard and soft technology for education and communication

for disabled people, Proc Int Comp Conf, Perth, Australia, 1984

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Mainstream Applications for People With Disabilities

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MAINSTREAM DERIVATIVES OF ASSISTIVE TECHNOLOGY*

Closed Captioning, Voice Recognition, On- screen Keyboards, Speech Synthesis,

Digitized Speech, Computer Keyboard Equivalents, MouseKeys, StickyKeys, T9 Disambiguation, Word Completion/ Prediction, Abbreviation Expansion, Single Latches on Laptops, On/Off Push button Toggle Switches, Call-out Control Descriptions, Screen Enlargement System, Color Schemes, Wearable Computers, Head Tracking Devices, Brainwave Recognition Units, Single Switch Hardware Interfaces

*Courtesy of R. Marsden…and more

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Implications of mainstream derivatives of AT

Are mainstream technologies more accessible to people with disabilities?

Do skills developed in using AT (including AAC technology) carry over to mainstream tech?

Does this succession of features lead to less need for custom AT?

Will agencies fund these devices given their greater functionality and applicability to disability needs?

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The Potential Downside•

Accessibility of phones, or iPad

Will apps really meet needs?•

How robust are the apps?–

Hobbyist kluge vs. professional development

Do you get what you pay for?•

Lack of support (Soft technologies)

Cultural relevance•

Language

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AAC-RERC

White Paper on Mobile Devices and Communication Apps

Based on interviews with 25 AAC “thought leaders” between January and March, 2011,

The idea that ANY one device can (or should) “do the job”

for individuals with CCN no longer makes sense

Many people with CCN, across the age span, require multiple technology options.

Some needs may be met by mainstream technologies, while others may require accessories and techniques designed specifically for them

•www.aac_rerc.com

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White Paper Summary/Conclusions

The field needs to respond; in some cases provide guidance, and in others determine a new role

We need to maintain professionalism during this change; partnering will serve the AAC professional better than resistance.

Keeping the holistic perspective of AAC is crucial

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Issues in AAC•

Attitudes impact AAC effectiveness

Variety of AAC techniques and strategies

AAC is multi-modal•

There are barriers to successful AAC use

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How many ways do I have to ask?

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Mulitmodal

AAC communication•

AAC is an integrated set of components, including the symbols, aids, strategies and techniques used by individuals to communicate.

AAC intervention should always be multimodal, that is, using all the individual communication skills, including vocalizations, residual speech, gestures, signs and aided communication.

American Speech-Language-Hearing Association (1991). Report: Augmentative and alternative communication, Asha, 33 (Suppl. 5), 9-12

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AAC Formats

Unaided•

Facial expressions

Body language•

Gestures

Vocalizations•

Manual sign language

Aided •

Writing

Non-electronic communication displays

Low tech AAC devices•

High tech AAC devices

Software for Mainstream Devices

Phone and email

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Circle of Friends5

432

1 Client

Fifth circle –

Unfamiliar partners (“everyone else”

who doesn't fit in the first four circles)

Fourth circle –Paid workers (SLP, PT, OT teachers, educational assistant, babysitter)

Third circle –

Acquaintances (neighbors, schoolmates, bus driver, shop keeper)

Second Circle – Close

friends/relatives

First circle life-

long communication partners

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Different communication modes are typically used with different partners-as

represented by the five circles

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Communication is Multi-modal Using Multiple Modes to Tell a Story

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Michael Williams on various modes and when to use them

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Issues in AAC•

Attitudes impact AAC effectiveness

Variety of AAC techniques and strategies

AAC is multi-modal•

There are barriers to successful AAC use

Page 42: Albert M. Cook Faculty of Rehabilitation Medicine and Faculty of …aerdpq.reseaut.net/fichiers/evenement/conference/5-ac_a... · 2011-08-15 · Issues in AAC Albert M. Cook Faculty

Issues: Barriers

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ParticipationModel

Opportunity Barriers Access Barriers

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*Participation Model (Beukelman

& Mirenda)

Policies

Practices

Attitudes

Knowledge

Skills

Opportunity barriers*

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Access barriers*•

Environmental Potential:–

Limited natural abilities

Natural supports •

AAC potential–

Operational profile

Constraints profile–

Capability profile

*Participation Model (Beukelman & Mirenda)

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Funding•

Can drive access

Balance required between cost and function

Can be a major barrier for people with disabilities who depend on assistive technologies and know what they need to succeed

Multiple AAC modes can lead to greater cost

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Summary of Issues in AAC•

Attitudes impact AAC effectiveness

A Variety of AAC techniques and strategies can be used

AAC is multi-modal for everyone•

There are opportunity and access barriers to successful AAC use that must be overcome

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Questions or comments?

Page 49: Albert M. Cook Faculty of Rehabilitation Medicine and Faculty of …aerdpq.reseaut.net/fichiers/evenement/conference/5-ac_a... · 2011-08-15 · Issues in AAC Albert M. Cook Faculty